1376530659 NPI number — DRSRX, INC

Table of content: (NPI 1376530659)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376530659 NPI number — DRSRX, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRSRX, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CLARK DRUG STORE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376530659
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1130
Provider Second Line Business Mailing Address:
2116 HWY 367N
Provider Business Mailing Address City Name:
BALD KNOB
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72010-1130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-724-3261
Provider Business Mailing Address Fax Number:
501-724-6507

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2116 HIGHWAY 367 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALD KNOB
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72010-9443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-724-3261
Provider Business Practice Location Address Fax Number:
501-724-6507
Provider Enumeration Date:
10/03/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CURD
Authorized Official First Name:
KELLY
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER/PHARMACIST
Authorized Official Telephone Number:
501-724-3261

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  AR8165 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: AR20377 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 156437716 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 152539407 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".